Basic Information
| Provider Information | |||||||||
| NPI: | 1164471934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHANAHAN | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 N ELM ST | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | HINSDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605213634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6328566865 | ||||||||
| FaxNumber: | 6308566813 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 WINTHROP AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601391405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305455700 | ||||||||
| FaxNumber: | 6305455784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 04/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36057774 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.